Healthcare Provider Details

I. General information

NPI: 1396111209
Provider Name (Legal Business Name): DARREN HIDESHI IWAMOTO ED.D., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 HARDING AVE SUITE 509
HONOLULU HI
96816-3735
US

IV. Provider business mailing address

2302 AHAIKI ST
PEARL CITY HI
96782-1105
US

V. Phone/Fax

Practice location:
  • Phone: 808-739-1992
  • Fax:
Mailing address:
  • Phone: 808-457-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-187
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: